HIV 2 – Treatment

WHERE ARE WE WITH HIV TREATMENT?

Treating HIV early keeps people living with HIV alive, healthier and reduces the spread of HIV. For this reason, and in line with World Health Guidelines, South Africa has a ‘test-and-treat-all’ policy, making all populations and age groups eligible for treatment regardless of CD4 count.^1a
With approximately 7.5 million people (of all ages) in South Africa living with HIV at the end of 2019, there is still an enormous need to create awareness and improve access to effective medicines for all.^2a,3a

HOW IS HIV TREATED?

There is no cure for HIV, but treatment with HIV medicines, called antiretroviral therapy (ART), can slow or prevent HIV from advancing from one stage to the next. HIV medicines help people live longer, healthier lives.^4a
People on antiretroviral therapy take a specific combination of HIV medicines every day, called an ART regimen.^4bThese regimes are based on World Health Organisation and Infectious Disease Specialist recommendations. The recommendations again are based on their ongoing monitoring of data of HIV infection and treatment patterns and are subject to change as new information and drug developments become available. HIV medicines are grouped into different drug classes according to how they fight HIV at different stages of the HIV life cycle.^4b

WHAT ARE THE BENEFITS AND GOALS OF HIV TREATMENT?

All people living with HIV are eligible to be provided with lifelong treatment, regardless of age, clinical status or CD4 count, including children, adolescents and adults, and pregnant and breastfeeding women.^1b,5a
Treatment can offer the following benefits to patients:^4a,c,6a

slow down and prevent the progression of HIV through the stages 1 to 4
help people with HIV live longer and healthier
reduce the risk of transmission to HIV-negative people. One of the main goals of treatment is to reduce a person’s viral load to an undetectable level. People with HIV who maintain an undetectable level of virus in their blood have no risk of transmitting HIV to others, including their HIV-negative sexual partner

DECIDING ON TREATMENT FOR EACH PATIENT

The World Health Organisation and National guidelines recommends ART for all people with HIV as soon as possible after diagnosis without any restrictions of CD4 counts.^1a,6b
Certain steps must be taken to decide on appropriate therapy for each individual patient. These are:^1c

Determine the timeframe for starting treatment
Decide on first- or second-line treatment
Choose the drugs in the regimen
Provide education to encourage adherence to medication

In some instances, treatment will not be started immediately after diagnosis. Special screening (testing) will be done to find out if a patient has tuberculosis (TB) or any other chronic condition or infection that may affect the type of medication that can be prescribed.^1d
For example, if a patient is found to have TB at the time of testing for HIV, antiretroviral therapy will only be started after a minimum of 2 weeks after starting TB treatment when a person is stable on the TB treatment.^1e For further information on HIV and co-infection with TB.
Starting daily antiretroviral therapy as soon as possible after diagnosis and staying on treatment are essential for keeping HIV under control, which benefits individual health and prevents HIV transmission to others.^7a

DIFFERENT TYPES OF HIV MEDICINES

HIV medicines are grouped into different classes according to how they fight HIV.⁴There are currently 5 main classes of antiretrovirals in South Africa.⁸

Some HIV medicines are available in fixed-dose combinations which means there is more than one medicine combined into one tablet. This reduces the burden of multiple pills and may improve treatment adherence.⁸
The following table lists the names of the medicines (active ingredients) and their unique identifying abbreviation.⁸ This information is quite complex and if you have any questions relating to specific medicines, please ask your healthcare professional

*Ritonavir is used in combination with a Protease Inhibitor (/r)in order to improve efficacy.⁸

DID YOU KNOW?

Because of antiretrovirals, HIV infection has transformed from an almost uniformly fatal infection into a manageable chronic condition!⁷

WHEN WOULD A PATIENT REQUIRE A SWITCH OF THERAPY FROM FIRST-LINE TO SECOND-LINE OPTIONS?

The starting point for HIV treatment is a first-line treatment regime. A person may have to be switched onto ‘second-line treatment’ if the current medications they are on are not working well enough to keep the viral load low.^1j
Together with an increased viral load on repeated occasions, declining CD4 and/or increased opportunistic infections will confirm that the medication will need to be changed.^1j
A ‘failure’ of medication is sometimes caused by suboptimal treatment adherence.^1j Before switching, the reasons for medication ‘failure’ will be assessed. These include:^1k